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1 TO ALL SUPPLIERS SEEKING REGISTRATION AS AN APPROVED SUPPLIER ON THE DATABASE OF THE ENTITY SMALL ENTERPRISE FINANCE AGENCY (sefa) All suppliers are herewith invited to register as an approved supplier on the database of sefa In order to comply with the procedures set out in the Accounting Officers Procurement Procedures (AOPP), as referred to in the Public Finance Management Act, 1999 (Act 1 of 1999)(PFMA), the entity sefa developed a supplier database to be used by the procurement office. The purpose of this database is to give all prospective suppliers an equal opportunity to submit quotations to sefa. Preference will be given to registered suppliers but it does not necessarily follow that suppliers who are not yet registered will be totally exempted from quoting for the supplying of goods or services to sefa. It is envisaged however, that this database will contribute to efficient administration and compliance with the PFMA. Attached please find an official registration form to assist us in updating our database according to legislation. It is imperative that suppliers read the application document carefully, complete it in full and sign it. The Database form must be accompanied with the following: Certified copy of Company Registration documents (CIPRO) certificate; Shareholders Certificates; Certified copy of valid VAT Registration Certificate (where applicable); Certified ID copies of owners/shareholders/members; Certified copy of B-BBEE certificate issued by a Verification Agency accredited by SANAS / registered Auditor approved by IRBA or an Accounting Officer; An original valid Tax Clearance Certificate must be attached; Workers compensation fund letter for proof of registration; Company profile or individual history, inclusive of relevant experience & expertise; and A track record of the company/individual with traceable references. Applications without the relevant aforementioned information shall be disqualified. You will be informed of the outcome of your application. When completed please hand deliver to: Eco Fusion 5, Block D, 1004 Teak Close, Eco Park, Centurion For Attention: SEFA - The Supplier Database Administrator Procurement Officer or alternatively send it to: Private Bag X28423 SUNNYSIDE 0132 For attention: SEFA - The Supplier Database Administrator 1

2 SUPPLIER APPLICATION FORM IMPORTANT NOTES Please read carefully To be completed by all vendors seeking registration as an approved supplier; The questionnaire must be completed in full and be signed; A company profile may accompany the registration form but will not be accepted as substitute for the application form all fields on application form must be completed by applicant; Applicants will be contacted via fax and must therefore submit an operating fax number, failure to comply will result in excluding the supplier from the data base; It should be noted that SEFA reserves the right to accept or reject any application without being obliged to give any reasons in this respect; Suppliers will be notified whether their application was accepted or not; Supplier must comply with all the registration-criteria for registration to be finalised - failure to do so may result in the application being declined; and An original valid tax clearance certificate must be attached - failure to do so may result in the application being declined. Supplier detail: Company / Supplier Name: Company / Close Corporation Registration Number VAT registration number (if applicable): Income tax reference number: Web Address: Address: Telephone Number: Fax Number: (compulsory) Toll Free Number: Number of full time employees: Postal Address: (compulsory) Physical Address: (compulsory) Postal Code: Company/Supplier Classification: (Please the relevant box or boxes) ISO Listed Importer Services Manufacturer Repairer Black Owned Distributor Exporter Sales (Please the relevant box) Tax Clearance Certificate Attached yes no Expiry date: 2

4 SMME status of your enterprise: Please use this table to determine the SMME Status of your enterprise Please the relevant box in each column A. Sector B. Full time paid employees C. Annual Turnover (millions) D. Total Gross asset value (property excluded) (millions) Medium Small Very Small Micro Medium Small Very Small Micro Medium Small Very Small Micro Agriculture Mining and Quarrying Manufacturing Construction Retail and Motor trade Wholesale Trade Catering, Accommodation Transport, Storage Finance & Business Services Repair/Allied Services Communication s Other Trade Commercial Agents Community& Social Services Personal Services SMME status of your enterprise: (Please the relevant box) (According to SMME table) (Compulsory) Micro Very Small Small Medium Large List all partners, proprietors and shareholders (compulsory) Name Position occupied in the enterprise Citizenship ID Number Note: Where owner are themselves a company or partnership, owners of the holding firm must be identified. 4

5 HDI Ownership Status: Please read notes below very carefully Instructions and Definitions: (Please read carefully before completing HDI Ownership Status) Legislation: Procedures are set out in the Accounting Officers Procurement Procedures (AOPP), as referred to in the Public Finance Management Act, 1999 (Act 1 of 1999)(PFMA), to give all prospective suppliers an equal opportunity to submit quotations to a State Department or Entity. Terminology: Commodities: The commodities the company wishes to be registered for as a supplier to SMALL ENTERPRISE FINANCE AGENCY Trade Names: The trade names that the company own or distribute, which you wish to be registered for as a supplier to SMALL ENTERPRISE FINANCE AGENCY. Owned: Having all the customary elements of ownership, including the right of decision-making and sharing all the risks and profits commensurate with the degree of ownership interests as demonstrated by an examination rather than the form of ownership arrangements. Previously Disadvantaged Individuals (PDI): For the purpose of registering as a supplier for SMALL ENTERPRISE FINANCE AGENCY, the refutable presumption shall be made that SA citizens who fall into population groups that had no franchise in national elections prior to the introduction of the 1983 and 1993 constitution are Previously Disadvantaged Individuals. It is incumbent on individuals to demonstrate their claims to fall into such population groups on the basis of identification and association with and recognition by the members of such a group. Women: A female person who is a SA citizen. Establishment of PDI / Women Equity Ownership in a enterprise: Equity ownership shall be equated to the percentage of an enterprise which is owned by individuals, or in the case of a company, the percentage shares that are owned by individuals who are actively involved in the management and daily business operations of the enterprise and exercise control over the enterprise, commensurate with their degree of ownership. Where individuals are not actively involved in the management and daily business operations and do not exercise control over the enterprise commensurate with their degree of ownership, equity ownership may not be claimed. HDI Ownership Status: (Failure to complete this section will result in the application being declined) Previously Disadvantaged Individuals (PDI) % Women Equity (WE) % Disabled Individuals (DA) % B-BBEE Level (Attach Certificate / Exemption Letter) Declaration of any conflict of interest: 5

6 I/we the undersigned acknowledge(s) that: The information furnished is true and correct; The Equity Ownership claimed is in accordance with the General Conditions; Any conflict of interest will be declared in the comment space below; An official sefa order will be accepted; Payment of any goods delivered or service rendered will be effected within 30 days from receipt of invoice; and SIGNATURE OF OWNER OR AUTHORISED REPRESENTATIVE DATE SIGNATURE OF OWNER OR AUTHORISED REPRESENTATIVE DATE Comments / Notes / Conflict of Interest: 6

8 SUPPLIER DETAILS CREDIT ORDER INSTRUCTION COMPANY'S FULL TRADING NAME (please print clearly) 1. I/We hereby request and authorise you to pay any amounts which accrue to me/us to the credit of my/our account with the mentioned bank. ENTERPRISE REGISTRATION NUMBER Year Number 2. I/We understand that the credit tranfer hereby authorised will be processed by computer through a system known as the "ACB Electronic Fund Service", and I/We also understand that no additional advice of payment will be provided by my/our bank, but details of each payment will be printed on my/our bank statement or any accompanying voucher. (This does not apply where it is not customary for banks to furnish bank statements.) (Please attach a copy of the Registration Certificate) 3. I/We also understand that a payment advice will be supplied by sefa in the normal way, and that it will indicate the date on which funds will be available in my/our account. VAT NUMBER 4. This authority may be cancelled by me/us by giving thirty day's notice by pre-paid/registered post. IDENTITY NUMBER 5. I / We will not hold sefa liable for any payment not made into our bank account if the bank account details are incorrect or were not supplied to sefa prior to payment. BUSINESS ADDRESS Street: Suburb: City: Initials and Surname Authorised Signature Date Telephone and area code: ( ) Fax number and area code: ( ) Name of Bank POSTAL ADDRESS Street: Name of Branch Suburb: City: Code: Branch Code Account Name Account Number Account Type* PAYMENT ADDRESS Street: *Please enter numeric value: Suburb: 1 = Cheque Account 4 = Bond Account City: 2 = Savings Account 5 = (Not in use) Code: 3 = Transmission Account 6 = Subscription Account Please complete this form then post or hand deliver the original to: SEFA Private Bag X28423, Sunnyside, 0132 or Eco Fusion 5, Block D, 1004 Teak Close Witch Hazel Avenue, Eco Park, Centurion DATE STAMP OF BANK FOR COMPLETION BY BANK OFFICIAL: Bank account details are hereby certified as being correct: Name: ID Number: Signature:

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